Tool Kit Part V Additional Perioperative Nursing Care This tool kit contains five slide decks related to the management of surgical smoke in the perioperative setting We recommend that you review the slide decks in order ID: 1046924
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1. Management of Surgical SmokeTool KitPart V: Additional Perioperative Nursing Care
2. This tool kit contains five slide decks related to the management of surgical smoke in the perioperative setting. We recommend that you review the slide decks in order. This is Part V.Part I: Introduction to Surgical Smoke Part II: Hazards of Surgical SmokePart III: An Overview of Health Care Regulations, Standards, and Guidelines Related to Surgical SmokePart IV: Smoke Evacuation in the Perioperative SettingPart V: Additional Perioperative Nursing CareInstructions to the Learner
3. Part VAdditional Perioperative Nursing Care
4. Perioperative Nursing Care
5. Patient assessmentWill your patient be exposed or potentially be exposed to surgical smoke?DiagnosisPlanning careInterventions and evaluation of outcomesPatient outcomesPerioperative Nursing Care
6. Remember that general room ventilation and smoke evacuation are the first line of protection from surgical smoke.Wear appropriate PPE.Surgical Attire
7. PPE: MasksSurgical masks and high-filtration surgical face masksFluid resistant, loose-fitting face maskProtects wearer from large droplets, splashes, spraysNot a reliable way to protect wearer from inhaling contaminants Does not create a seal between the wearer’s face and the mask
8. PPE: MasksHigh-filtration surgical face maskDesigned to filter particulate matter that is 0.1 micron in size or largerA surgical mask is not considered respiratory PPE.
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10. Wear PPE (ie, respiratory protection) as secondary protection from surgical smoke.Minimum requirement is a fit-tested surgical N95 filtering face piece respirator (ie, N95 respirator)Wear an N95 respirator duringHigher-risk, aerosol-generating proceduresProcedures on patients known or suspected to have aerosol transmissible diseases tuberculosis (TB), varicella, rubeolaRespiratory Protection
11. Wear a fit-tested surgical N95 filtering face piece respirator fordisease transmissible cases (eg, human papillomavirus [HPV])aerosol transmissible diseases (eg, TB, varicella, rubeola)aerosol-generating procedures (eg, bronchoscopy)Respiratory Protection
12. Communication with the surgeon and perioperative team membersPlan for smoke evacuation Equipment and optimal placement of equipmentSmoke protection methods for the patient and team membersTeam Briefing
13. Include PPE and respiratory protection/mask optionsType of smoke evacuation method being usedHand-Over Communication
14. Use standard precautions when disposing of used smoke filter devices and other used smoke equipment.Safe Handling
15. DocumentationRelevant information about smoke evacuation and equipment used
16. Policies and ProceduresAddress best practices for the patient and the perioperative teamNational regulatory and professional standardsCredentials, competency, and trainingEquipmentOperational guidelinesPatient and health care worker incidents
17. Surgical smoke compliance study 2009To identify key indicators of compliance with surgical smoke evacuation recommendationsSmoke Evacuation:Compliance Study
18. Individual Innovativeness Characteristics(Perioperative nurse characteristics)Perceptions of Attributes(Nurses’ perceptions of smoke evacuation recommendations)Organization Innovativeness Characteristics(Organization’s characteristics)No complianceFull complianceAgeEducation levelExperienceKnowledgeTrainingPresence of respiratory problemsRelative advantageCompatibilityComplexityTrialabilityObservabilityBarriers to practiceDescriptors (locale, type)SizeComplexityFormalizationInterconnectednessLeadership supportBarriers to practiceCompliance with research-based smoke evacuation recommendationsSmoke Evacuation Compliance Study: Compliance Model** Based on Roger’s Diffusion of Innovations model. Reprinted with permission from Kay Ball, PhD, RN, CNOR, FAAN.
19. Key indicators of complianceEducationLeadership supportEasy to follow policiesRegular internal collaborationSmoke Evacuation Compliance Study
20. November 2010Survey e-mailed to current, active members of AORNNorth American health care facilities 1,356 responses/10,000 emailed requestsCompared findings from 2007 similar studyPerioperative RN Survey
21. The use of wall suction during laser procedures (excepting laser hair removal and LASIK) is similar to that for electrosurgery, electrocautery, diathermy, or ultrasonic scalpel procedures.There is a lower incidence of smoke evacuator use than wall suction use.The smoke evacuator use rates did not change significantly between 2007 and 2010.Few facilities routinely used effective respiratory protection for surgical smoke.Perioperative RN Survey:Study Findings
22. Define surgical smoke. Describe critical factors for managing surgical smoke for all procedures that generate surgical smoke. Describe the health effects of smoke exposure on patients and health care workers. Educational Outcomes and Competency
23. Explain the effect of particle size on the speed and distance smoke travels.Identify sources of surgical smoke: LasersESUsUltrasonic devicesHigh-speed drillsBurrsSaws Educational Outcomes and Competency
24. Participate in quality improvement programs related to the management of surgical smoke as assigned. Review policies and procedures related to smoke evacuation. Follow manufacturer’s instructions for use when cleaning, maintaining, and decontaminating smoke evacuation equipment.Educational Outcomes and Competency
25. Smoke Evacuation EquipmentSelect smoke evacuation systems and supplies in accordance with the procedure being performed. Test smoke evacuation equipment before the procedure.Connect equipment correctly. Use smoke evacuation equipment correctly during the procedure. Used Smoke Evacuation Equipment SuppliesUse standard precautions to handle used smoke evacuation supplies.Discard biohazardous waste.Educational Outcomes and Competency
26. Provide information and activities to help increase compliance with best practices for the management of surgical smoke.Quality and Safety Committee reportsEducational programs perioperative nursing careresearch on the hazards of surgical smokeequipment and suppliesSafety signsAORN postersChecklistsMonitor practicesIncreasing Compliance
27. Is surgical smoke: evacuated with a smoke evacuator, a laparoscopic filter, or suction with an in-line filter during all smoke-generating procedures?Is the smoke evacuation capture device: positioned as close as possible to the generation of surgical smoke to effectively collect all traces of the smoke?Is an additional standard suction used to evacuate fluid?Quality Monitoring and Performance Improvement – Compliance Indicators
28. Are smoke evacuation filters being used:according to manufacturer’s instructions for use?Are perioperative team members: wearing PPE when disposing of contaminated filters and smoke supplies?adhering to policies and procedures for smoke evacuation?It is important to: measure smoke evacuation practices by direct observationidentify barriers to smoke evacuation practicesHospital personnel can develop interventions toaddress barriers identifiedQuality Monitoring and Performance Improvement – Compliance Indicators
29. Thousands of hospitals make that claim.Let’s advocate to make the perioperative setting smoke-free as well.Protect Patients – Colleagues – Ourselves from the Hazards of Surgical Smoke http://www.cdc.gov/vitalsigns/TobaccoUse/Smoking/index.htmlAre Hospitals Really Smoke Free?
30. The EndCongratulations!